Summary: Researchers found no link between prenatal exposure to SSRI antidepressants and an increased risk of depression in children during middle childhood.
Source: WUSTL
In one of the first large-scale investigations of selective serotonin reuptake inhibitors (SSRIs) and early brain development, scientists from the Behavioral Research and Imaging Neurogenetics (BRAIN) Lab at Washington University in St. Louis report that exposure to SSRIs in utero was not independently associated with higher rates of depression in children around age 9–10.
The peer-reviewed study appears in Biological Psychiatry Global Open Science and analyzes data from the Adolescent Brain Cognitive Development (ABCD) Study, the largest long-term study of brain development in the United States.
Lead author Allison Moreau, a Ph.D. student in the BRAIN Lab led by Ryan Bogdan, examined data from more than 10,000 participants. Analytic sample sizes ranged from 5,420 to 7,528 children, including 235 with reported prenatal SSRI exposure. The researchers assessed caregiver-reported prenatal medication use, child depressive symptoms using the Child Behavior Checklist, and brain morphology measured by magnetic resonance imaging (subcortical volumes, cortical thickness, and surface area).
Initial analyses showed a modest increase in depressive symptoms among children prenatally exposed to SSRIs. However, after accounting for maternal depressive symptoms at the time of assessment, that association was no longer statistically significant. In other words, current maternal depression—rather than prenatal SSRI exposure—better explained the observed differences in child depression scores.
“After adjusting for the mother’s current depressive symptoms, we found no independent association between prenatal SSRI exposure and increased depression in middle childhood,” Moreau said. The team stresses that maternal mental health remains an important factor when considering child outcomes.
The study also examined brain structure to determine whether prenatal SSRI exposure was linked to measurable differences in cortical or subcortical anatomy. The authors observed small differences: children exposed to SSRIs in utero showed slightly greater thickness in the left lateral occipital cortex and a modestly larger surface area in the left superior parietal cortex compared with those who were not exposed. These differences were statistically detectable but very small in magnitude and were not related to depressive symptoms in the children.
“The anatomical differences we observed were minor and did not correlate with child depression,” Moreau said. “At this point, it’s unclear whether these subtle variations have any meaningful clinical consequence.”
SSRIs are commonly prescribed for depression and are also used to treat conditions such as obsessive-compulsive disorder and anxiety. Approximately 5.5 percent of pregnant people take SSRIs, and about 11 percent use them during their reproductive years, making the question of safety during pregnancy clinically important.
The study’s findings suggest that SSRI use during pregnancy should not be automatically discouraged based on concerns about increasing a child’s risk for depression in middle childhood. Instead, the results highlight the importance of addressing maternal depression itself when considering both prenatal care and long-term child outcomes.
Ryan Bogdan, the study’s senior author, noted that clinical decisions during pregnancy can feel especially difficult. “These data indicate that risk for depression during middle childhood associated with prenatal SSRI exposure should not, on their own, deter appropriate SSRI treatment during pregnancy,” he said. At the same time, he emphasized that science is ongoing: the current analysis captures depression outcomes at roughly 9–10 years of age, and many individuals develop depression later in adolescence or early adulthood.
Because the ABCD Study will continue to follow these children into young adulthood, researchers will have the opportunity to re-evaluate whether prenatal SSRI exposure relates to depression at older ages, when the average onset of depressive disorders increases. That longitudinal follow-up will be important for clarifying whether any delayed or age-dependent effects emerge.
About this neurodevelopment and depression research news
Author: Brandie Jefferson
Source: WUSTL
Contact: Brandie Jefferson – WUSTL
Image: The image is in the public domain
Original Research: Open access.
“Prenatal Selective Serotonin Reuptake Inhibitor Exposure, Depression, and Brain Morphology in Middle Childhood: Results From the ABCD Study” by Allison L. Moreau et al., Biological Psychiatry Global Open Science
Abstract
Prenatal Selective Serotonin Reuptake Inhibitor Exposure, Depression, and Brain Morphology in Middle Childhood: Results From the ABCD Study
Background
Prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) has been inconsistently linked to depression in offspring, and neural correlates remain poorly understood. This study evaluated whether prenatal SSRI exposure is associated with depressive symptoms and brain structure in middle childhood.
Methods
Researchers used retrospective caregiver reports of prenatal SSRI exposure, caregiver-reported child depressive symptoms (Child Behavior Checklist), and MRI-derived measures of brain structure in children (analytic n values = 5,420–7,528; 235 with prenatal SSRI exposure; ages 9–10) who completed the baseline ABCD Study visit. Linear mixed-effects models accounted for nested data and controlled for familial, pregnancy, and child covariates. Matrix spectral decomposition corrected for multiple comparisons.
Results
After adjusting for recent maternal depressive symptoms, prenatal SSRI exposure was not independently associated with child depressive symptoms. Prenatal SSRI exposure was associated with a greater left superior parietal surface area (b = 145.3 mm2, p = .00038) and increased lateral occipital cortical thickness (b = 0.0272 mm, p = .0000079); neither brain measure correlated with child depressive symptoms. Child depressive symptoms were associated with smaller overall brain structure.
Conclusions
These findings, together with evidence of adverse outcomes associated with maternal depression and the benefits of SSRIs for treating depression, suggest that concerns about middle childhood depression alone should not automatically preclude SSRI use during pregnancy. Associations between prenatal SSRI exposure and brain morphology were small and unrelated to depression. Continued longitudinal study through adolescence and young adulthood is needed to determine whether associations change as risk for depression increases with age.